Funda malunga neentlobo ezahlukeneyo zonxibelelwano
Ukuba uqeshwe okanye uzenzele imeko apho ufuna ukufumana eyakho inshorensi yempilo, ukhetho olukhoyo kuwe lunokudideka. Ewe, iiphakheji ezixhamlayo zilungelelaniswa, ngokubonga kuMthetho woNonophelo ojongene noNcedo, kodwa ezinye iinkalo zengxelo ziyahluka kakhulu kumgaqo-nkqubo ukuya kumgaqo-nkqubo.
Ngexa uthengisa, uya kuhlunga ngokwemiqathango efana ne-HMO, i-PPO, iintlawulo zentsebenziswano kunye neentlawulo, zonke ezo zinto zingasongela ukuba awukwazi ukuba zithetha ntoni.
Indawo efanelekileyo yokuqala, nangona kunjalo, kukujonga uhlobo lomnatha-ntanethi olunikezelwa kwimigaqo-nkqubo eyahlukeneyo: i-HMO, i-PPO, kunye nemali-yeenkonzo.
I-HMO (UmNyango weMpilo yoNondlo)
Uninzi lwezicwangciso oza kufumana lubekwe kunye kwaye lukhuphe utshintsho lwempilo yomshuwalense wezempilo lwakho luya kuba yi-HMO icebo. Ezi zicwangciso zivame ukuba zikhetho ezincinci.
Ii-HMO zifuna ukuba unike ukuguquguquka xa ukhetha ugqirha okanye isibonelelo sonyango kwaye unamathele eluhlu lwababoneleli abafakwe kwi-HMO. Kwezinye iimeko, olu luhlu lunokuthintela. Unokufuneka ufumane ukuthunyelwa kwirejista yakho yokunyamekela ukuze ubone ingcali.
Izicwangciso ezimiselwe njenge-HMO zinokuthi zibizwa ngokuba yi "intanethi evaliweyo," oko kuthetha ukuba umgcini-mali uya kuhlawula nayiphi na into ekunyamekeleyo ukuba ubona ugqirha okanye omnye umboneleli wezempilo ongekho kwinethiwekhi. Unonophelo olungxamisekileyo ngokubanzi lukhutshwe, nangona kunjalo, nokuba lwenzeka ngaphandle kwe-network.
Uya kuba neentlawulo zentsebenziswano, eyona sabelo sakho sokuhlawula kumgqirha okanye kwabanye ababoneleli, kunye ne-deductible, eyinani elimiselweyo eliya kufuneka lihlawule unyango lwezonyango phambi kokuba u-inshurensi uza kuqala ukuhlawula.
I-PPO (UmPhathiswa oMenzi weMboleki)
Izicwangciso ze-PPO zikunceda ukuguquguquka kunokuba i-HMO, kwaye ngokuqhelekileyo ixabisa kakhulu ...
ngamanye amaxesha, ngakumbi, kuxhomekeke kwisicwangciso esithile.
Njengoko i-HMO, i-PPO iya kuba noludweliso lwababanikezeli "abakhethiweyo" - oogqirha kunye nezibhedlele ezivumile ukuthatha inxaxheba kwisicwangciso. Aba banikezeli babizwa ngokuba ngababoneleli ngee-network, kwaye kuya kubiza ngaphantsi ukuba ubone aba bahlinzeki.
Kananjalo unakho ukhetho lokutyelela omnye umnikezeli ozikhethele yona nangona bengekho kwinethiwekhi. Kule meko, i-inshurensi yakho inokufakela inxalenye yenkonzo, kodwa ngokuqhelekileyo uya kufuneka uhlawule ipesenti enkulu ephakamileyo lakho.
Njengemigaqo-nkqubo ye-HMO, iipolisi ze-PPO nazo ziya kuthwala iinqununu kwaye zifune iintlawulo zentsebenziswano.
Umgaqo-nkqubo weNkonzo
Imigaqo-nkqubo ye-Fee-for-service (FFS) (ngamanye amaxesha ebizwa ngokuba yizicwangciso zentlawulo) iyaba yinto engaphantsi kweyona nto iyaqhelekileyo-eneneni, awufumani nanye nakwimeko yakho. Ngokuqhelekileyo luhlobo olubi kakhulu lwe-inshurensi yezempilo.
Kwizicwangciso zentlawulo-ngenkonzo, unokhetha ugqirha kunye naluphi na isibhedlele ofuna. Uhlawula ngokuthe ngqo iibhili, uze ufake ifayili kunye ne-inshurensi yakho ukuba ubuyiselwe iirhafu.
Njengazo zonke iinkqubo zeminshuwalense yezempilo, umgaqo-mali-wenkonzo-nkqubo uya kufuna ukuba uhlawule iirhafu kunye neentlawulo zentsebenziswano kwiinkonzo zakho zonyango.
I-HMO kunye neMali yeNkonzo kunye nePPO Plans Plans
Xa uqhathanisa izicwangciso zempilo ezahlukeneyo, kufuneka uqale ngezinto ezibaluleke kakhulu kuwe nakwintsapho yakho.
Ukuba ukhetha ugqirha wakho kubaluleke kakhulu kuwe, ngoko uya kufuneka ukhethe i-HMO okanye i-PPO edibanisa ugqirha wakho, okanye ukhethe isicwangciso-ntlawulo-sokunikwa kwenkonzo (kuthathwa enye ifumaneka kwingingqi yakho).
Ukuba ngakolunye uhlangothi, ukugcina iindleko zakho phantsi kunzima, unokuba ufuna ukujonga ngakumbi kwi-HMO. Nangona kunjalo, qaphela ukuba ungakhohliswa yi-premium ephantsi-qinisekisa ukuba uqhathanisa iindleko zokuphuma ngaphandle kweendleko. Emva kokuba uzimisele ukuba luhlobo luni lwesicwangciso oluya kuhambelana nawe, unokuqala ukujonga izicwangciso ezifanayo kwicala.